Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
81 Cards in this Set
- Front
- Back
|
hCG source
|
placental synsytiotrophoblast;
in blood 10 days after fertilization peaks 9-10weeks, falling to plateau in 20-22 weeks |
|
|
hCG structure
|
alpha subunit similar to LH, FSH, thyrotropin
beta subunit is specific |
|
|
hCG functions
|
maintain corpus luteum production of progesterone until placenta
regulate steroid synthesis in placenta and fetal adrenals stimulate testosterone production in fetal male testes |
|
|
excess hCG
|
twin pregnancy
hydatiform mole choriocarcinoma embryonal carcinoma |
|
|
low hCG
|
ectopic pregnancy
threatened abortion missed abortion |
|
|
human placental lactogen
|
similar to GH and prolactin
levels rise with placental growth antagonizes insulin, predisposes to gestational diabetes if low --> threatened abortion, intrauterine growth restriction |
|
|
progesterone source
|
6-7 weeks --> corpus luteum
7-9 weeks --> corpus luteum and placenta >9 weeks --> increasingly the placenta |
|
|
progesterone functions
|
early pregnancy --> induces endometrial secretory changes for blastocyst implantation
late pregnancy --> induces immune tolerance for pregnancy and prevents myometrial contractions stimulates the development of milk-producing alveolar cells |
|
|
estrogen varieties
|
estradiol (non-pregnant)
estriol (pregnancy) estrone (menopause) |
|
|
estradiol
|
non-pregnant reproductive years
androgens from follicular theca cells diffuse to granulosa cells aromatase in granulosa cells converts androgens to estradiol promotes the growth of breast ducts antagonizes prolactin in breast |
|
|
estriol
|
main estrogen in pregnancy
DHEA-S from fetal adrenals is converted to estriol by placental sulfatase promotes the growth of breast ducts antagonizes prolactin in breast |
|
|
estrone
|
menopause estrogen
adrenal androstenedione is converted by peripheral adipose tissue to estrone |
|
|
physiologic skin changes in pregnancy
|
striae gravidarum stretch marks in genetically predisposed
spider angiomata and palmar erythema from increased vascularity Chadwik sign --> bluish vagina and cervix from increased vascularity linea nigra --> hyperpigmentation between pubis and umbilicus chloasma --> blotchy pigmentation of nose and face |
|
|
physiologic cardiovascular changes in pregnancy
|
arterial BP --> decreased (increase is never normal)
femoral venous pressure --> increased SVR --> decreased CO --> increases up to 50% by 20 weeks (increased HR and SV) plasma volume --> increased up to 50% by 30 weeks systolic ejection murmur is normal; diastolic murmurs are abnormal |
|
|
physiologic hematologic changes in pregnancy
|
RBC increases by 30% but there's dilutional effect (not anemia)
WBC increase up to 16,000 ESR increases coagulation factors VII, VIII, IX, X increase --> hypercoagulable state |
|
|
physiologic GI changes in pregnancy
|
decreased gastric motility --> increased stomach residual volume --> gravid uterus stomach displacement --> can predispose to aspiration pneumonia with general anesthesia
decreased colonic motility --> fluid absorption --> constipation |
|
|
physiologic pulmonary changes in pregnancy
|
all volumes are decreased except tidal volume which increases up to 40% --> compensated respiratory alkalosis
|
|
|
physiologic renal changes in pregnancy
|
kidney hypertrophy
increased ureteral diameter (more on the right) GFR and creatinine clearance increase glucose treshold decreases to 155mg/dL --> glucosuria urine protein is unchanged |
|
|
physiologic endocrine changes in pregnancy
|
pituitary increased by 100% --> predisposes to Sheehan from postpartum hypotension
adrenals are unchanged but cortisol increases 2-3x thyroid size increases 15%, TBG and total T3/T4 increase |
|
|
fetal circulation shunts
|
ductus venosus --> from umbilical vein to inferior vena cava (byoasses liver)
foramen ovale --> from right to left atrium ductus arteriosus --> from pulmonary artery to descending aorta |
|
|
prolactin
|
from anterior pituitary stimulates milk production
|
|
|
oxytocin
|
from posterior pituitary causes milk ejection in response to suckling
|
|
|
postconception week 1
|
day 0 --> fertilization in the distal oviduct
day 3 --> entry of morula into uterine cavity day 6 --> implantation of the blastocyst onto endometrium, formation of trophoblast (placenta) and embryonic cells |
|
|
postconception week 2
|
bilaminar germ disk with epiblast and hypoblast
invasion of maternal sinusoids by syncytiotrophoblast beta-hCG passes to maternal blood |
|
|
postconception week 3
|
trilaminar germ disk
|
|
|
postconception weeks 4-8
|
organ formation
risk of teratogenesis |
|
|
paramesonephric duct
|
Mullerian duct needs no hormonal stimulation to become female internal organs
Mullerian inhibitory factor produced by Sertoli cells in males causes Mullerian duct involution |
|
|
mesonephric duct
|
Wolffian duct needs testosterone from Leydig cells to develop into male reproductive system
absence of testosterone in females causes Wolffian involution |
|
|
female external genitalia
|
needs no hormonal stimulation to form
|
|
|
male external genitalia
|
dihydrotestosterone produced by 5-alpha reductase from testosterone is needed for formation
|
|
|
genetic male with androgen receptor absence
|
Wolffian duct doesn't develop
external genitalia will not develop |
|
|
category A teratogen
|
controlled studies show no risk
acetaminophen, thyroxine, folic acid, magnesium sulfate |
|
|
category B teratogen
|
no evidence of risk in humans despite risks in animals
penicillins, cephalosporins, insulin, pepcid, reglan, paxil, prozac, benadryl, dramamine |
|
|
category C teratogen
|
risk cannot be ruled out, controlled studies are lacking in humans
codeine, methadone, AT, beta blockers, prilosec, heparin, protamine, robitussin, sudafed |
|
|
category D teratogen
|
postive evidence of risk but potential benefits may outweight the risks
aspirin, valium, tetracycline, depakote, lithium |
|
|
category X teratogen
|
contraindicated in pregnancy
isotretinoin, danocrine, pravachol, coumadin, cafergot |
|
|
infectious teratogens
|
chlamydia, gonorrhea --> neonatal eye and ear infections
rubella --> CMV --> herpes --> syphilis --> toxoplasmosis --> |
|
|
ionizing radiation teratogenicity
|
no risk with exposure <5 rads (diagnostic procedures)
risk proportional to doses above 20rads |
|
|
chemotherapy teratogenicity
|
risk in the first trimester
|
|
|
environmental teratogens
|
alcohol --> alcohol fetal syndrome
tobacco --> IUGR and preterm delivery cocaine --> placental abruption, IUGR, preterm delivery marijuana --> preterm delivery |
|
|
fetal alcohol syndrome
|
IUGR
midfacial hypoplasia developmental delay short palpebral fissures long filtrum joint anomalies cardiac defects |
|
|
diethylstilbestrol syndrome
|
category X teratogen
T-shpaed uterus vaginal adenosis predisposition to vaginal clear cell carcinoma cervical hood incompetent cervix preterm delivery |
|
|
fetal hydantoin syndrome
|
due to Dilantin, category D teratogen
IUGR craniofacial dysmorphism mental retardation microcephaly nail hypoplasia heart defects |
|
|
isotretinoin as teratogen
|
category X teratogen
congenital deafness microtia CNS defects congenital heart defects |
|
|
lithium as teratogen
|
category D teratogen
produces Ebstein's anomaly (right heart defect) |
|
|
streptomycin as teratogen
|
VIII nerve damage
hearing loss |
|
|
tetracycline as teratogen
|
category D teratogen
teeth discoloration after 4th month |
|
|
thalidomide as teratogen
|
category X teratogen
phocomelia limb reduction defects ear/nasal anomalies cardiac defects pyloric or duodenal stenosis |
|
|
trimethadione as teratogen
|
facial dysmorphism
cardiac defects IUGR mental retardation |
|
|
valproic acid as teratogen
|
class D teratogen
neural tube defects, spina bifida cleft lip renal defects |
|
|
warfarin as teratogen
|
category X teratogen
chondrodysplasia microcephaly mental retardation optic atrophy |
|
|
indications for genetic counseling
|
advanced maternal age >35
multiple fetal losses previous child with congenital defects or neonatal death pregnancy or fetal losses family history of birth defects or mental retardation abnormal prenatal tests (triple marker screen, sonogram) parental aneuploidy |
|
|
Turner syndrome
|
45X due mostly to paternal loss of X
98% abort spontaneously ultrasound shows nuchal skinfold thinkening and cystic hygroma survivors have primary amenorrhea, web neck, streak gonads, absence of secondary sex features, infertility, broad chest, neck webbing, aortic coarctation |
|
|
Klinefelter syndrome
|
47XXY
tall stature testicular atrophy gynecomastia azoospermia truncal obesity learning disorders and low IQ |
|
|
Down syndrome
|
trisomy 21
short stature mental retardation endocardial cushion defects short stature short neck typical facial appearance duodenal atresia Alzheimer |
|
|
Edward syndrome
|
trisomy 18
profound mental retardation rocker-bottom feet clenched fists 1 year survival is 40% |
|
|
Patau syndrome
|
trisomy 13
profound mental retardation cleft lip with palate holoprosencephaly 1 year survival is 40% |
|
|
vacuum curetage
|
90% of induced abortions
performed before 13 weeks prophylactic antibiotics, conscious sedation, paracervical block for pain relief dilation and curettage (D&C) complications --> endometritis, retained products of conception |
|
|
medical abortion
|
mifepristone (progesterone antagonist) and misoprostol (prostaglandin E1)
must be used in first 63 days of amenorrhea 85% of patients will abort within 3 days |
|
|
second trimester abortion methods
|
dilation & evacuation
labor induction with hypertonic solutions of prostaglandins |
|
|
spontaneous abortion definition
|
bleeding that occurs before 12 weeks gestation
MCC is fetal in origin |
|
|
etiology of spontaneous abortion
|
gross chromosomal abnormalities
mendelian defects antiphospholipid syndrome |
|
|
spontaneous abortion work-up
|
speculum exam to rule out vaginal or cervical lesions as cause of bleeding
molar and ectopic pregnancy should be ruled out RhoGAM administration to all Rh-negative gravidas who undergo D&C |
|
|
missed abortion
|
sonogram finding of nonviable pregnancy
no vaginal bleeding, uterine cramping or cervical dilation management: scheduled D&C OR conservative management awaiting completion OR misoprostol |
|
|
threatened abortion
|
sonogram finding of a viable pregnancy with vaginal bleeding but no cervical dilation
management: observation |
|
|
inevitable abortion
|
vaginal bleeding and uterine contractions leading to cervical dilation but no POC
management: emergency suction D&C to prevent further blood loss |
|
|
incomplete abortion
|
vaginal bleedingm uterine contractions, cervical dilation and some POC passes
management: emergency suction D&C to prevent further blood loss |
|
|
completed abortion
|
vaginal bleeding and uterine contractions with all POC passed
confirm by sonogram showing no intrauterine contents management: conservative if previous intrauterine pregnancy had been diagnosed or serial beta-hCG weekly until negative to rule out ectopic pregnancy |
|
|
fetal demise definition
|
in utero death of fetus after 20 weeks
antenatal demise --> occurs before labor intrapartum demise --> after onset of labor |
|
|
fetal demise complications
|
DIC if fetal demise >2weeks (dead fetus releases tissue thromboplastin)
prolonged grief resolution |
|
|
fetal demise risk factors
|
MCC is idiopathic
antiphospholipid syndrome maternal diabetes maternal trauma severe maternal isoimmunization fetal aneuploidy fetal infection |
|
|
fetal demise presentation and diagnosis
|
before 20 weeks --> uterine fundus less than dates
after 20 weeks --> mother reports absence of fetal movements diagnosis --> ultrasound showing no fetal cardiac activity |
|
|
fetal demise management
|
exclude DIC --> platelets, d-dimer, fibrinogen, PT, PTT; if present then inmediate delivery
if DIC not present --> deferred delivery or conservative management with weekly coagulation tests delivery: if <20 weeks or no autopsy --> D&E if >20 weeks or autopsy --> prostaglandins for induction of labor |
|
|
ectopic pregnancy presentation
|
secondary amenorrhea
unilateral abdominal/pelvic pain vaginal bleeding unilateral adnexal tenderness cervical motion tenderness if ruptured --> signs of hypotension, abdominal guarding and rigidity |
|
|
ectopic pregnancy differential diagnosis
|
if positive beta-hCG -->
threatened abortion incomplete abortion ectopic pregnancy hydatiform mole |
|
|
ectopic pregnancy risk factors
|
pelvic inflammatory disease
tuboplasty/ligation DES idiopathic |
|
|
ectopic pregnancy diagnosis
|
presumption of ectopic pregnancy --> beta-hCG > 1,500 mIU + no intrauterine pregnancy with vaginal sonogram
repeat beta-hCG & sonogram in 2-3 days if beta-hCG hasn't doubled --> ectopic pregnancy else --> IUP; exclude threatened abortion or hydatiform mole |
|
|
ectopic pregnancy management
|
ruptured ectopic --> emergency laparotomy to stop bleeding
unruptured ectopic --> methotrexate (if criteria met) or laparoscopy/laparotomy if methotrexate or salpingostomy --> weekly beta-hCG to confirm resolution of pregnancy Rh-negative women --> RhoGAM |
|
|
methotrexate criteria for ectopic pregnancy
|
pregnancy mass <3.5cm diameter
absence of fetal heart motion beta-hCG <6,000mIU no history of folic acid supplementation |
|
|
chorionic villus sampling
|
catheter is placed into placental tissue without entering amniotic fluid at 10-12 weeks gestation
chorionic villi are aspirated tissue is sent for karyotyping |
|
|
amniocentesis
|
performed after 15 weeks
needle is placed under ultrasound guidance and amniotic fluid is aspirated amniocytes are sent for karyotyping neural tube defects are screened with alphafetoprotein and acetylcholinesterase |
